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. 2021 Nov 22;7(12):e795.
doi: 10.1097/TXD.0000000000001208. eCollection 2021 Dec.

Neurogenic Orthostatic Hypotension: a Common Complication of Successful Pancreas Transplantation

Samantha A Kuten  1 , Edward A Graviss  2 , Duc T Nguyen  2 , A Osama Gaber  3 , Archana R Sadhu  4 , Ericka P Simpson  5 , Stephanie G Yi  3 , Hemangshu Podder  3 , Anna Kagan  6 , Richard J Knight  3
Affiliations

Neurogenic Orthostatic Hypotension: a Common Complication of Successful Pancreas Transplantation

Samantha A Kuten et al. Transplant Direct. .

Abstract

Background: Orthostatic hypotension (OH) is a poorly understood complication of simultaneous pancreas-kidney (SPK) transplantation. We sought to determine the incidence, timing, and relationship of OH to rapid glycemic control in the early posttransplant period.

Methods: This was a nonrandomized retrospective single-center review of 75 SPK and 19 kidney-alone (KA) recipients with type 1 diabetes (DM).

Results: OH occurred in 57 (76%) SPK versus 2 (10%) KA recipients (odds ratio [OR] 61.72, 95% confidence interval [CI], 9.69-393.01; P < 0.001). The median onset of OH was 12 (interquartile range [IQR] 9-18) days posttransplant and resolved in 85% of SPK recipients after a median of 2.5 (IQR 1.2-6.3) months. Among SPK recipients, independent risk factors for OH were a shorter duration of DM (OR 0.85, 95% CI, 0.73-0.98; P = 0.03) and rapid glycemic control in the early posttransplant period (OR 1.13, 95% CI, 1.01-1.27; P = 0.04), as evidenced by a larger percent change in hemoglobin A1c (HbA1c) from transplant to month 3. OH patients had a higher median baseline HbA1c [8.3% (IQR 7.2-10.0) versus 7.1% (IQR 6.8-8.3); P = 0.07], lower median 3-month HbA1c [4.8% (IQR 4.6-5.2) versus 5.2% (IQR 5.0-5.4); P = 0.02], and a larger reduction in HbA1c over time as compared to recipients without OH (P < 0.01).

Conclusions: Our results show that OH is more likely to occur following SPK versus KA transplantation and is strongly associated with rapid glucose normalization within the early posttransplant period.

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Conflict of interest statement

The authors declare no funding or conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Change in hemoglobin A1c from day 0 to posttransplant month 3 between SPK recipients with orthostatic hypotension (OH) vs no orthostatic hypotension (no OH). SPK, simultaneous pancreas–kidney.
See this image and copyright information in PMC

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